Is the “Dutch test” a good marker to use in peri and menopause? Is fasting a good approach to amenorrhea? Snack options between meals? And, do you recommend zero carbs?
Get the answer to these questions in this week’s Q&A with fertility specialist Dr. Fox:
I am a 52-year-old perimenopausal woman. Had a hysterectomy a year and a half ago. Also hypothyroid. I have been trying to research about peri and menopause and how I should approach it. Is the “ Dutch test” a good marker to use?
I have been doing the keto for a month now, do I check my thyroid more often? I hear that it changes when you implement this diet. I did IVF at 40 and was hyperstimulated. Does this put you into menopause sooner?
I don’t know about the “Dutch test.” It is sad to me that people are having to resort to such home testing modalities as this Dutch test in order to guide their doctors. I would tell you not to waste your money. If your ovaries were removed with surgery and 98% chance even if they were not removed, you will need estrogen supplementation/replacement. It is my opinion that all women in menopause and even a little before the need to start estrogen. For average ovarian function women, I am starting estrogen supplementation in the 43/44 age range on average. Find a hormone friendly physician to discuss it further.
It is actually good that the uterus is gone because now you do not need progesterone supplementation. Progesterone is a negative metabolic hormone. Without added estrogen, your metabolic system will suffer and you will gain weight and be less healthy. Yes if you have hashimotos type hypothyroidism, the antibody load may dramatically decrease on ketogenic approach and you may need less supplemental thyroid hormone.
Lastly, no – IVF with hyperstimulation only utilizes eggs that were going to disappear anyway during that particular cycle and does not reduce your egg count faster than normal. Best of luck…
Fasting with amenorrhea
My daughter has not had a regular period for five years. She tried BCP three times and was not successful and now we have no interest in going that route. She has seen gynecologists and endocrinologist and everything looks ok. She is 22 now. Her health history has involved a lot of antibiotic/laxatives and stress. She has a few autoimmune disorders (psoriasis and possibly thyroid). She has tried to go the natural path with Dr. Jolene Brighton as well. My question to you is: Do you think fasting is ok for her? She has a very normal weight. Normal BMI. She has been intermittent fasting with bulletproof coffee but we have been discussing a cleaner fast. What is your opinion?
Thank you for your time,
It is hard to comment on the amenorrhea. All things cannot be “OK” if amenorrhea or severely irregular cycles are the norm? If her weight is normal, my guess is that she suffers from physiologic stress-induced ovulation dysfunction. Stresses, we have alluded to in other answers but primarily center around, over exercise (aerobic), nutritional stress (hypoglycemic spells, or anorexia, bulimia, starvation weight loss, fasting), sleep disturbance or sleep apnea, to name a few. So as you can see, fasting would fit the category of stress, thus making the cycles worse. One other very significant stress signal comes from caffeine. There are no other people on the anti-caffeine bandwagon with me, but this is a huge problem for our population. Caffeine and amphetamine/cocaine have very similar effects. She probably needs estrogen as well but this is hard to sort out without more extensive interaction through history and labs. I am not a huge fan of intermittent fasting for females. Only in those that are dramatically overweight who are primarily seeking big weight loss. Hope this helps…
If im hungry between meals what are my options to snack on? And im only eating two meals a day?
You need to be eating every three hours at least 150 calories. Two meals a day creates stress and works against you. Snacks have been covered elsewhere on the website but should be absolutely no carb and high fat. Bacon, cheese, boiled eggs, meats, unflavored pork rinds are all good snacks. Look further on our low-carb snacks guide. Thanks…
Do you recommend zero carb?
In some of your videos, I’ve heard you say “as close to zero carb as possible”. I did an all meat (ribeye, ground beef, and eggs) diet for six weeks and loved it, and was wondering if that’s something you’d recommend for someone trying to get pregnant (after failed IVF).
Maybe I should qualify that. Our recommendation is high fat, modest protein (correct amount for weight, 1-1.5 g/kg ideal body wt) and non-starchy vegetables. If you eat vegetables, you will get some carbs. In my experience, unless you are in a severe insulin function category, you can tolerate nonstarchy vegetables. The further north of BMI 40 you get, the fewer vegetable carbs you could tolerate. So if you don’t fit the worst case scenario, we tell patients for normal servings of one or two vegetables per meal, they can ignore those carbs. The zero would apply to all other foods. In reality, this sets the threshold under 20 g per day that everyone agrees produces solid ketosis. Hope that helps.
More questions and answers
Read all earlier questions and answers to Dr. Fox – and ask your own! – here: